Healthcare Provider Details

I. General information

NPI: 1326784638
Provider Name (Legal Business Name): SARAH NICOLE LARSON MD, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2022
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MARTIN LUTHER KING DR
MANKATO MN
56001-6460
US

IV. Provider business mailing address

MCHS PROVIDER ENROLLMENT PO BOX 55486
MINNEAPOLIS MN
55486-0912
US

V. Phone/Fax

Practice location:
  • Phone: 507-625-4031
  • Fax:
Mailing address:
  • Phone: 507-375-3391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number77770
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number33568
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: